Kidney Cancer

A growth of malignant cells in the kidney resulting in the formation of a tumour. Kidney cancer like other urogenital cancer is on the rises but the reason is partially due to improved medical technology with increase in detection of smaller and early stage renal cell cancer. It was used to say that 50% of renal cell cancer associated with spread when diagnosed but this is changing due to increase use of abdominal ultrasound in detecting intra-abdominal tumour.

Risk factors

The risk factors for kidney cancer are:

  • Family history of kidney cancer (especially, von-Hippul Lydau Disease,polycystic disease of the kidneys)

  • Smoking​

Symptoms and signs

Kidneys are situated at the lower back region and the mass enlargement will not cause pain until it reaches a large size. Some of the common symptoms of kidney cancer are:

  • blood in the urine

  • pain at the loin

Other symptoms related to the lungs, bone and brain are as a result to the spread of the cancer, which is rare presenting complaint for kidney cancer.

multi-focal large kidney cancer (radical nephrectomy specimen)

CT scan shows tumour at the right kidney

Investigations

There are 2 different types of investigation related to the kidney cancer:

  • intravenous urogram (IVU) or ultrasound

  • CT scan of the abdomen

When the patient presented with blood in the urine or loin pain or colicky pain, intravenous urogram (IVU) or ultrasound will be the initial investigations for this complaint. However, IVU may not be accurate as the lesion may not be able to detect by the contrast outline of the kidney. 

 

Ultrasound (US) is better to pick up kidney lesion, especially in patients with diabetic, asthma and kidney disease. Nevertheless, ultrasound may not be able to pick up lesion in the ureter and cannot assess kidney functions.

If the kidney lesions is detected, the next investigations will be CT scan of the abdomen to determine the nature of the lesion and to stage the lesion whether it has spread to the regional lymph nodes or involvement of the renal vascular structure.​

Treatment

Treatment of the kidney cancer will depend on the stage of the cancer as well as the fitness of the patients. The treatment may be as follow:

  • surgery

  • radiotherapy; or/and

  • chemotherapy

Surgery

If the lesion is small and there is no systemic effect, surgery will be the main modality of treatment especially when the lesion is small and focal, partial removal of the lesion with a clear margin will cure the patient. Lifelong follow up is necessary to detect recurrence

However, if the lesion is too big and more than 5cm then removal of the whole kidney is necessary (radical nephrectomy) because there may be synchronous lesion elsewhere in the same kidney and the part that left behind may not worth to do a partial as there is more blood loss. The removal of the whole kidney will be unavoidable when there is a healthy contralateral kidney.

Nowadays, minimal invasive surgery will be the operation of choice as the patient will have less pain, smaller scar and shorter hospital stay without affecting the outcome.

Scars of a 3cm incision

Radiotherapy

Radiotherapy has very little effect on the primary cancer especially when it is big. However, radiofrequency treatment may be effective for lesion less than 2 cm especial when the patient is not fit for surgery

Chemotherapy

If the cancer have spread beyond the confined of the kidney to the lungs, brain and one, then chemotherapy especially the target focos-chemotherapy will have some effect on kidney cancer and the patient has 30-40% partial response with the control of the cancer.

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